Healthcare Provider Details

I. General information

NPI: 1386856052
Provider Name (Legal Business Name): STAR RICE DEVELOPMENTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 WEST NEW INDIAN TRAIL COURT
AURORA IL
60506
US

IV. Provider business mailing address

217 TANGLEWOOD LN
NAPERVILLE IL
60563-2777
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-4412
  • Fax: 630-844-2065
Mailing address:
  • Phone: 630-966-4412
  • Fax: 630-844-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: